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v <br /> SAX JOAQUIN COLNW PUBLIC KEALTH SERVICES _4a <br /> ENVIROIN-NMNTAL B'EALTH DrV`ISIGN <br /> UNDERGROUND STORAGE TANS DISPOSITION TR;aCSUNG RECORD <br /> +Wrtr.r.+.}rtVanw+Yi#W.#f!!w}.}}iziiir.'A}}}}}n#weYniwll}rtw}i}#•iw.T#W#+wWMM+n+wwrtW..••rWz+.rt+.ffF}iyzi+zni}swz.n <br /> ind <br /> SECTION I -Public Health Servkm Eavirorimental Health Division Tank Tracking Shut anall accompany each tank a Divi lon <br /> its site idaneficarion number. -he Tank Trackng Sheet is to be returned w Public Health S�iccs Environments!Health iv.7 to a <br /> within 30 dss of acceptance of the tank by the disposal or racyclLlg facility. The permit holder is respo:s ok for ersuriry sat <br /> this foray is completed and returned. <br /> 7ACIL"PYNAME: San Joaquin County Mosquito & VPrtnr <br /> COII+rnl Pi ctrl r+ <br /> 200 N. Beckman Rd. , Lodi , CA 95240 <br /> - gACILIIY-acDDRESS: / t <br /> -ANK ID*39- I 6 TANK SIZE: SOo IOUS TANK CO`'T"r,.v'TS. <br /> •}'in+.nwW!FrWzrtnw.}n}Wwn.Y..nW+Y}#Wia>al.wi}nyziMliWii+#M}#MWW#Min#}}Y}�v#iwiiiiA!ii}}+#rrtziixMW.rt+.W W}W an.rt�in <br /> SECTION 2-To be filled out by tank removal corstraetor: <br /> Jim Thorpe Oil , Inc. <br /> Tank :2eemval coricmaor: <br /> P.O. Box 357 City: Lodi, CA Zia: 95241-0357 <br /> Address: <br /> ?hone <br /> 209 368-6175 Date Tank Removed: <br /> SECTION 3 -To be tilled out by cortinctor"decontarniasting tank": <br /> Tank Decontamination Con actor: JIm Thorpe Oil , Inc. <br /> Address: <br /> P.O. Box 357 City Lodi . CA_Zip' a5 .d— <br /> Phone d: (_�209 368-6175 <br /> '. <br /> Autaorsed representative of contractor caviNing thru.}signature below t.iat the tank has been decontaminated m as apprcvri <br /> manner as required by Cal EPA. <br /> yam.; Martin Thorpe Tide: Vice Pres. Sig-lacuDate. <br /> — <br /> zyyi.w.w}}iwi}+i}}wv,si+.rt##1./awlrn+bi}.w}+rt+i+A..}.w�W#}... ..........• <br /> ++n.W.iwW#......w!'k:F}}}x}wWaea+nwll}}a}} <br /> SECTION 4 acceptTo be ing Lack i by an�o�representative of the atment, srorage, or disposal Pxilin' <br /> Facility Hams: <br /> WEST COAST EQUIPMENT, <br /> 1221 S. Tegner Road City: Turlock, CA Zip. 95380 <br /> Address: <br /> Phone#: (-2-0—9) <br /> Date Tank Received: <br /> Si ire. Dam�� <br /> Name. Title: <br /> ......p.W.i.... ...+ .......... ........FWi* 'nW+rrt.W.rw+ WW+.....�.i..,u..iv.}Wae..i.Yiviir}:.rt}x .... <br /> E3 .3 046 (Revised C8115!99) <br /> Page 10 <br />